MEDICARE: KELLY MARIE SHERIDAN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0730000626	VA

General Provider Information

NPI Number	:	1659035640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE SHERIDAN LMFT

Provider Business Mailing Address
First Line	:	858 OLD JERSEY MOUNTAIN RD
Second Line	:
City	:	ROMNEY
State	:	WV
Zip	:	26757-6562
Country	:	US
Telephone Number	:	304-578-9315
Fax Number	:	304-990-0371

Provider Business Practice Location Address
First Line	:	117 E PICCADILLY ST STE 300
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-5002
Country	:	US
Telephone Number	:	540-665-4426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	04/26/2026

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